348 Alhambra Circle, Coral Gables (305) 447-9199 dentistry@lesliehallerdmd.com
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# Your airway can still grow — even as an adult.

Most of us have been told that our jaws and palates are fixed. They are not. Through epigenetic remodeling, the dental arches can be gradually expanded — creating a structurally larger, more resilient airway without surgery, without breaking bone, and without a lifetime of dependence on a machine. Expanding an adult airway is not as easy as it is in a child, and it takes much longer — but it can be done.

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Adults
of all ages can be treated
12–24
months typical treatment period
Permanent
structural change — not just management
No
surgery or hospitalization required
An investment in permanent change
Most patients consider the cost of expansion treatment in the context of what they would otherwise spend on CPAP equipment, replacement supplies, and sleep studies over a lifetime. Many find expansion significantly more cost-effective over time.
Recognizing the signs

## Do you have an airway problem? Most adults don’t know.

Sleep apnea and airway restriction in adults often present with symptoms that have nothing to do with sleep — and are commonly attributed to stress, aging, or lifestyle. Many adults have lived with a restricted airway for decades without realizing it.

Sleep symptoms

- Snoring — any snoring is a sign of airway turbulence
- Waking unrefreshed despite 7–8 hours
- Gasping or choking during sleep
- Witnessed apneas
- Excessive daytime sleepiness
- Mouth breathing during sleep
- Dry mouth or sore throat on waking
- Morning headaches

Pain & structural

- Teeth grinding (bruxism) — jaw thrusting forward to open airway
- TMJ pain, clicking, or locking
- Chronic neck, shoulder, upper back tension
- Forward head posture
- Frequent nighttime urination (nocturia)
- Acid reflux — especially at night
- High blood pressure resistant to medication
- Crowded teeth or narrow palate

Cognitive & systemic

- Brain fog, difficulty concentrating
- Memory problems
- Depression or anxiety — often improve once sleep is restored
- Weight gain despite diet and exercise
- Chronic fatigue — never feeling fully rested
- Reduced libido
- Tinnitus — ringing in the ears
- Diminished sense of smell

“Most of my adult patients have been living with these symptoms for so long they’ve accepted them as normal. They think the fatigue is just aging, the bruxism is just stress, the reflux is just diet. When we address the airway, the whole picture often shifts.”
— Dr. Leslie Haller, DMD

## If the airway is the cause, opening it is the answer.

Recognizing an airway problem is the first step. The next is doing something about it — not by managing the symptoms one by one (CPAP at night, a splint for the jaw, medication for the reflux), but by addressing the anatomy itself.

Adult airway expansion physically opens the airway by allowing the tongue to come forward. The dental arches widen, the nasal passages enlarge, and the airway becomes structurally more resilient — less prone to collapse during sleep, less reliant on a nightly device to stay open. The treatments that follow on this page (oral appliances, expansion, NRT, tongue tie release, myofunctional therapy) all work toward that same end.

What makes this possible — even in adults — is a piece of biology most people, and most clinicians, were never taught.

The science

## How epigenetic arch remodeling works.

The mid-palatal suture and other growth centers of the adult skull remain biologically active throughout life — and they hold stem cells capable of building new bone. Epigenetic expansion uses gentle, intermittent pressure from a removable appliance to activate those stem cells, gradually widening the dental arches, expanding the nasal passages, and creating a structurally more resilient airway.

1
Appliance worn 14–18 hours/day
A custom, removable appliance is fitted over the teeth and worn 14–18 hours per day — including overnight and through much of the day. Gentle, consistent pressure is applied to the palate, the dental arch, and the roots of the teeth.
2
Stem cells activated
The intermittent pressure activates stem cells along the median palatal suture and around the roots of the teeth — the same growth centers that built the jaw in childhood. No drastic force, no broken bone.
3
New bone grows slowly
The activated stem cells lay down new bone at the suture lines and around the dental arch. The process is gradual — measured in fractions of a millimeter per week — which is what makes it sustainable and stable over time.
4
Airway permanently changes
As the arch widens, the nasal passages open and the airway becomes structurally more resilient. The key measure is not airway size alone — it is the airway’s resistance to collapse during sleep.
5
Muscles retrained
Myofunctional therapy runs alongside expansion — retraining the tongue, lip, and throat muscles to support the new structure and maintain results for life. Muscle tone is as important as anatomy.
What we now know — collapsibility, not just size
The field of airway dentistry is continually evolving. Early research focused on measuring increases in airway cross-sectional area — and impressive changes were documented. We now understand that a healthy airway depends not just on size. Shape and resistance to collapse are as important. An airway with strong muscle tone and good structural support can function well even if it is not dramatically larger. This is why Dr. Haller’s approach combines structural expansion with myofunctional therapy — addressing both the anatomy and the neuromuscular support that keeps the airway open. A low tongue position with open lips leads to airway instability. Closing the lips allows the tongue to rest on the palate and stabilizes the airway. That is why mouth taping has become more and more emphasized as a simple and inexpensive way to improve sleep immediately. Of course, you have to be able to breathe through your nose easily to be able to mouth tape — so nasal strips or NRT can help you achieve your mouth taping goal.
Understanding your options

## MAD device vs. airway expansion — what’s the difference?

Both approaches address sleep apnea and airway restriction. The key difference is permanence. A MAD device manages the airway during sleep. Expansion changes the anatomy itself.

Feature | MAD Device | Airway Expansion
--- | --- | ---
What it does | Holds jaw forward during sleep to prevent airway collapse | Widens the dental arch and nasal passages — changes the anatomy permanently
Permanence | Maintenance only — must be worn every night for life | Permanent structural change — results remain after treatment ends
Treatment period | Indefinite — worn nightly forever | 12–24 months of active treatment
Nightly device afterward | Yes — every night | No device needed once treatment is complete for many patients
Effect on nasal breathing | None | Widens nasal passages — improves nasal breathing directly
Tongue tie evaluation | Not typically included | Always evaluated and released first if present
Myofunctional therapy | Not typically included | Integrated throughout — muscle tone is part of the outcome
Insurance | Many medical plans cover for diagnosed OSA — sleep study required | Generally not covered — fee-for-service with Letter of Medical Necessity
Best for | Immediate relief, CPAP intolerance, bridge to expansion | Long-term resolution, patients who want to address root cause

A rapidly evolving field
The science of adult airway expansion is advancing quickly. What we understood five years ago has already been refined — and what we know today will continue to evolve. Dr. Haller trains continuously with the leading practitioners in this field to ensure her patients benefit from the most current protocols and understanding. She is not attached to any single system — she uses what the evidence and her clinical experience support.

## What changes when the airway opens.

Patients come to Dr. Haller for sleep apnea, snoring, or TMJ pain. What they often discover is that addressing the airway has effects they never anticipated — in their cognition, their pain levels, their senses, and their quality of life.

Real patient outcomes
“I had tinnitus for years. After airway treatment, it went away. I didn’t even know to expect that.”
Tinnitus resolved
“My husband told me he could smell his wife’s perfume for the first time. He hadn’t known he couldn’t smell it.”
Sense of smell restored
“The TMJ pain I’d had for twenty years was gone within six months of starting treatment. I’d tried everything else.”
TMJ pain eliminated
Cognitive & neurological

- Brain fog lifting
- Memory improvement
- Tinnitus reduction or resolution
- Improved sense of smell
- Reduced anxiety and depression
- Improved energy and motivation

Musculoskeletal

- TMJ pain and clicking reduced or resolved
- Chronic neck and shoulder tension improved
- Headaches and migraines reduced
- Forward head posture improvement
- Bruxism reduced or resolved
- Facial asymmetry improvement over time

Breathing & sleep

- Snoring reduced or eliminated
- Sleep apnea events reduced
- Nasal breathing established or improved
- Waking refreshed — often for the first time in years
- Partner sleep improved
- Reduced or eliminated CPAP dependence

Systemic health

- Blood pressure reduction
- Acid reflux improved
- Nocturia reduced
- Weight management easier
- Cardiovascular risk reduced over time
- Energy and exercise tolerance improved

A note on expectations
Not every patient experiences all of these changes — and results vary based on starting anatomy, compliance, age, and the full treatment protocol used. The outcomes listed above are drawn from real patient experiences in Dr. Haller’s practice. At your consultation, Dr. Haller will give you an honest assessment of what is realistic for your specific situation.
Frequently asked questions

## Questions adults ask most.

I was told adult palates can’t be expanded. Is that true?
No — this is an outdated belief. The mid-palatal suture and other craniofacial growth centers remain biologically active throughout adult life. Epigenetic expansion in adults has been well-documented in published research and in clinical practice. Dr. Haller has treated many adult patients who had been told elsewhere that expansion wasn’t possible for them.
How is this different from braces or Invisalign?
Traditional orthodontics moves teeth within an existing arch — it does not expand the arch itself. Epigenetic expansion actually widens the palate and creates more space, which simultaneously opens the nasal passages and improves the airway. Clear aligners may be used in the finishing stage, but they are not the expansion tool — they refine tooth positions after the structural work is done.
How long does treatment take?
Most adult patients wear an expansion appliance for 12–24 months. Results develop gradually throughout treatment and continue even after the appliance phase ends. Some patients notice meaningful improvements in breathing and sleep within the first few months. Individual results depend on starting anatomy, age, and compliance.
Does insurance cover this?
Our practice is fee-for-service. Expansion appliances are generally not covered by insurance. Custom MAD devices for diagnosed OSA are often covered by medical insurance — we provide all necessary codes for submission. We provide a Letter of Medical Necessity for all treatments and can discuss payment options at consultation.
I have a tongue tie. Does that need to be released before expansion?
Not necessarily. Dr. Haller evaluates every adult airway patient for tongue tie. When one is identified, the release and myofunctional therapy can run alongside expansion — they don’t have to come first. What matters is that all three work together: structural expansion, soft-tissue release, and muscle retraining. Dr. Haller will sequence them based on your specific situation.
Ready to find out if your airway can change?
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